Prokinetic Antiemetic (Peripheral Dopamine Antagonist) Pregnancy: Limited post-marketing data in pregnant women; animal studies showed reproductive toxicity at maternally toxic doses - use in pregnancy only when justified by the anticipated therapeutic benefit. Breast-feeding: excreted in human milk (breast-fed infants receive <0.1% of the maternal weight-adjusted dose); adverse effects, particularly cardiac, cannot be excluded - decide whether to stop breast-feeding or the drug.

Domperidone

Brand names: Motilium

Domperidone is a peripheral dopamine D2-receptor antagonist with prokinetic and antiemetic activity, used for the short-term relief of nausea and vomiting.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 10 ml of oral suspension (domperidone 1 mg/ml)

Route: Oral

Frequency: Up to three times per day, taken 15-30 minutes before meals/feeding

Max: 30 ml per day (of the 1 mg/ml oral suspension)

Fetched source is the Domperidone 1 mg/ml Oral Suspension SPC; at the stated 1 mg/ml concentration 10 ml delivers 10 mg domperidone. Applies to adults and adolescents 12 years of age and older weighing 35 kg or more. Use the lowest effective dose for the shortest duration necessary to control nausea and vomiting; maximum treatment duration usually should not exceed one week. If taken after meals absorption is somewhat delayed. Do not double a missed dose. Paediatric population: efficacy has not been established in children under 12 years, nor in adolescents 12 years and older weighing less than 35 kg - no weight-based dose is given in the SPC; verify against a children's formulary. Hepatic impairment: contraindicated in moderate (Child-Pugh 7-9) or severe (Child-Pugh >9) impairment; no dose modification needed in mild (Child-Pugh 5-6) impairment.

Dose adjustments

Renal

In severe renal impairment (serum creatinine >6 mg/100 mL, i.e. 0.6 mmol/L) the elimination half-life is prolonged: reduce dosing frequency to once or twice daily depending on severity, and the dose may need to be reduced. Review such patients regularly.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Known hypersensitivity to domperidone or any of the excipients
Prolactin-releasing pituitary tumour (prolactinoma)
Confirmed or suspected phaeochromocytoma (risk of severe hypertensive episodes)
Where stimulation of gastric motility could be harmful - gastrointestinal haemorrhage, mechanical obstruction or perforation
Moderate or severe hepatic impairment
Known existing prolongation of cardiac conduction intervals (particularly QTc), significant electrolyte disturbances, or underlying cardiac disease such as congestive heart failure
Co-administration with QT-prolonging drugs (with the exception of apomorphine) or with potent CYP3A4 inhibitors

Side effects

Dry mouth (common)
Somnolence, headache (uncommon)
Diarrhoea (uncommon)
Rash, pruritus (uncommon); urticaria and angioedema (not known)
Blood prolactin increased, galactorrhoea, gynaecomastia, breast pain/tenderness, amenorrhoea
QTc prolongation, torsade de pointes, ventricular arrhythmias and sudden cardiac death (frequency not known)
Extrapyramidal disorder, convulsion, oculogyric crisis (frequency not known)

Interactions

QT-prolonging drugs: co-administration contraindicated, except apomorphine where benefit outweighs risk and the precautions in the apomorphine SmPC are strictly followed
Potent CYP3A4 inhibitors: co-administration contraindicated regardless of their QT-prolonging effect
Levodopa: plasma levodopa concentration increased (max 30-40%), although no levodopa dose adjustment is deemed necessary
(§4.5 was not included in the fetched bundle - the above are taken from SPC §4.3/§4.4; verify against the full SPC)

Clinical monograph

How it works

It blocks peripheral dopamine D2 receptors in the chemoreceptor trigger zone and upper gastrointestinal tract, promoting gastric emptying and suppressing nausea while largely sparing central effects as it poorly crosses the blood-brain barrier.

Prescribing in practice

It prolongs the QT interval and is associated with serious ventricular arrhythmias and cardiac death, so it is contraindicated in significant cardiac disease, QT prolongation, electrolyte disturbance and with other QT-prolonging or strong CYP3A4-inhibiting drugs, and should be used at the lowest effective dose for the shortest time.
It is contraindicated where stimulation of gut motility could be harmful, such as gastrointestinal obstruction, haemorrhage or perforation.
Cardiac risk is greater in older patients and at higher doses, reinforcing short-duration use.

Monitoring

Assess cardiac and electrolyte risk before and during treatment, reviewing concomitant QT-prolonging and CYP3A4-inhibiting drugs and keeping the course short.

Counselling the patient

Take this medicine for as short a time as possible to settle nausea and vomiting.
Tell your prescriber about any heart problems or other medicines you take.
Stop and seek urgent advice if you develop palpitations, fainting or an irregular heartbeat.

Evidence & guidelines

MHRA advice restricted domperidone to short-term symptomatic relief of nausea and vomiting at the lowest effective dose because of a small increased risk of serious cardiac side effects.

Reference: MHRA Drug Safety Update 2014 (Domperidone); SPC Motilium; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways